CAG Report Reveals Madhya Pradesh's Procurement of Banned Drugs Amid Fatal Cough Syrup Incident

Amid Cough Syrup Deaths, Auditor Flags Madhya Pradesh's Mega Purchase Of Banned Drugs

The drugs had been prohibited by the Central government since 2016.

As Madhya Pradesh grapples with the devastating loss of 23 children in Chhindwara from toxic cough syrup, a concerning report from the Comptroller and Auditor General (CAG) has uncovered systemic failures in the state's pharmaceutical regulation system.

According to the CAG's 2024-25 report, the Madhya Pradesh Public Health Services Corporation Limited (MPPHSCL) continued procuring and distributing medications explicitly banned for human consumption by India's government, creating significant public health risks.

Between 2017 and 2022, the corporation established rate contracts worth Rs 1.5 crore with pharmaceutical manufacturers for these prohibited medications and further acquired medicines valued at Rs 22.9 lakh through district-level local tenders, bringing the total expenditure on banned substances to Rs 1.8 crore.

The CAG document highlights that the Central Drugs Standard Control Organisation (CDSCO) had previously published a list of 518 medicines and fixed-dose combinations prohibited under the Drugs and Cosmetics Act, 1940. These formulations were banned by the Union Ministry of Health and Family Welfare for manufacturing, sales, and distribution for human use.

Despite these prohibitions, the audit revealed that MPPHSCL not only executed contracts for such medicines but facilitated their distribution throughout state health facilities. Among the prohibited medications purchased were fixed-dose combinations of Metronidazole + Norfloxacin (antibacterial and anti-amoebic medications), banned since March 10, 2016, yet supplied through contracts dated October 27, 2016, and July 1, 2017, totaling Rs 32.1 lakh. Additionally, the combination of Azithromycin + Cefixime (antimicrobials) was prohibited in 2016 but procured through contracts dated July 7, 2018, and August 16, 2020, worth Rs 1.2 crore.

The CAG observes that had the Corporation and Health Department exercised appropriate vigilance and removed these medications from procurement lists, such purchases could have been entirely avoided.

Examining the chronology, the report indicates that the Centre banned these fixed-dose drug combinations, including Metronidazole + Norfloxacin and Azithromycin + Cefixime, in 2016, with the Supreme Court upholding the prohibition in December 2017. The Centre further reinforced the ban through a new notification issued on September 7, 2018.

Nevertheless, Madhya Pradesh health authorities continued defending their procurement practices, claiming some combinations were supplied as medical kits (in pre-packaged form), a justification the CAG rejected as invalid. The audit concludes that the state corporation's failure to adhere to multiple notifications and court rulings constituted serious negligence, endangering patients across government hospitals and primary health centers.

The tragic deaths of 23 children following consumption of Coldrif syrup manufactured by Sresan Pharmaceuticals has heightened concerns about drug quality control mechanisms in the state, with public health experts noting that the CAG findings indicate a pattern of negligence that made such a tragedy almost inevitable.